Six-month implant newest option to treat addiction amid opioid crisis

Canadians addicted to opioids may be eligible for an implant that provides an ongoing low dose of medication for six months, with the potential for treatment for up to a year when a new implant is placed in the opposite arm.

The procedure involves trained physicians inserting match-stick sized rods under the skin of the upper arm, each containing the medication buprenorphine.

Health Canada approved the implant in April 2018, two years after it was granted approval in the United States. It is marketed under the brand name Probuphine and is the first such implant for the treatment of addiction to opioids.

Dr. Seonaid Nolan, a clinical researcher with the BC Centre on Substance Use and an addiction medicine physician at St. Paul’s Hospital in Vancouver, said the implant is another treatment option alongside medications including Suboxone, the recommended treatment for an opioid addiction, followed by methadone.

“It’s so important to have a number of treatment options because there’s no one-size-fits-all for turning the tide on the opioid crisis,” said Nolan, who is also medical director of the addiction program at Providence Health Care.

The implant’s main advantage is that it eliminates barriers such as patients having to remember to take daily tablets of Suboxone, which can be a particular challenge for those entrenched in addiction while battling issues such as poverty, lack of housing and unemployment, she said.

The implant would also do away with the need for patients to take a drug under supervision, at least initially, in order to ensure compliance and deal with risks of it being diverted or misused.

Nolan said one addiction-medicine doctor at St. Paul’s Hospital has been trained on how to insert the implant, considered a viable option for people being released from correctional facilities, residential treatment programs and prolonged hospital stays because their tolerance to illicit opioids would be markedly reduced, putting them at higher risk of overdose.

The Canadian Agency for Drugs and Technologies in Health, which reviews all drugs and devices approved by Health Canada, said in a statement it has recommended provincial drug plans reimburse the cost of the implant for patients who have been stabilized on no more than eight mg of buprenorphine, in conjunction with counselling.

The agency’s drug-expert committee says the cost of the implant should not exceed the total drug plan cost of buprenorphine at a dose not exceeding eight milligrams a day.

The Health Ministry in British Columbia, the hardest-hit province in the overdose crisis, with more than 3,000 fatalities over the past two years, said the province’s independent Drug Benefit Council is conducting its own review of the implant before it determines whether the cost will be covered.

Montreal-based Knight Therapeutics licensed the implant from a U.S. company to commercialize and distribute it in Canada.

Knight Therapeutics president Samira Sakhia said the cost would be $1,495 per implant, equivalent to six months of treatment on Suboxone.

The company has trained doctors in major Canadian cities on how to insert the implant, she said.

“We are early in our launch. What we’re trying to do is make sure that if a physician has a patient who they feel would benefit from Probuphine what we would do is co-ordinate with that physician so that if they’re not trained they have access to someone who is trained and is close enough to them and their patient.”

Sakhia said one patient, in the Maritimes, has so far received the implant in Canada.

“It’s a complicated product because of the nature of it being an implant and we are trying to do what we can to make sure that physicians are trained, knowledgeable, and we’re working towards reimbursement because that will make access easier.”